Delirium

• ​Infection
• ​Stroke, seizures, brain trauma
• Acute myocardial infarction
  
• Constipation and urinary retention
• Dehydration
• Electrolytes imbalances
• Pain
• Use of certain medications
• Alcohol use or withdrawal from alcohol
• Post surgery/procedures

• ​Advanced age
• Male
• History of dementia, depression and psychiatric illnesses
• Functional dependence and immobility
• Visual and hearing impairment
• Frailty
• Malnutrition
• Alcoholism
• Use of multiple medications
• Unfamiliar environment and use of restraints
  

​Treatment of delirium

• ​Treatment of delirium starts from early identification of delirium and then to find out what causes the delirium and treat the underlying causes.
• Apart from treating the underlying causes, there are some measures that we can do to help someone with delirium:
  • Familiar faces/environment - It is reassuring for people with delirium to see familiar faces or in a familiar environment. Do visit your loved ones often if possible. Bring personal mementos to remind them of home, such as photos, radio, or player with their favourite music.
  • Reality orientation - Orientating them to their surroundings will help to reduce confusion. Frequently orientate them to the time, place and person around them.
    
  • Correct sensory impairment - Help them put on their adaptive aid such as glasses and hearing aids to reduce confusion.
    
  • Activity engagement - Engaging them in daytime activities will help to improve the recovery. It can be physical exercises or social activities. Engaging them in things that they like to do/finding their previous hobbies will help us to choose a suitable activity for them. Examples: Art, music, colouring, handcraft, plant therapy, pet therapy, doll therapy and puzzles.
    
  • Encourage mobilisation - Allow them to walk about or sit out in the chair. But ensure that the environment is safe from fall and hazard free.
  • Hydration - Encourage to eat and drink. Patient with delirium may not ask for food/water. Hence it is important to offer and schedule food and water to prevent dehydration.
    
  • Sleep hygiene - Lack of sleep can worsen delirium. It is important to maintain a good sleep hygiene by ensuring that they sleep well at night. To do so, we need to avoid daytime napping, engage them in daytime activities and avoid caffeinated drinks in the late afternoon/night.
    
• If the delirium is severe to the point of causing harm to self and others, the doctors may use certain medications to improve the symptoms.
• Hence for family members, it is important to seek medical attention/inform healthcare workers if there is a sudden change in mental state and physical condition as family often is the first one to notice the change.

• ​Patients with delirium may be cared for in a specialised delirium unit run by a multidisciplinary team of doctors, nurses and therapist who are trained in managing patients with delirium. 
• This unit will also be equipped to provide a conducive environment for patients with delirium to recover.​